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Prepar t ic ipat ion Heal th Screen ing & Risk St ra t i f i ca t ion(Ron Jones, MS, ACSM Health/Fitness Instructor, Corporate Wellcoach)

According to the American College of Sports Medicine (ACSM), it is important to provide aninitial screening of participants relative to risk factors and/or symptoms for various chroniccardiovascular, pulmonary, and metabolic diseases to optimize safety during exercise testing and

participation and to develop a sound and effective exercise prescription. The purposes of thepreparticipation health screening include the following:

Identification and exclusion of individualswith medical contraindications to exercise.

Identification of individuals at increased risk for diseasebecause of age, symptoms,and/or risk factors who should undergo a medical evaluation and exercise testingbefore starting an exercise program.

Identification of persons with clinically significant disease who shouldparticipate in amedically supervised exercise program.

Identification of individuals with other special needs.

Health screening procedures must be valid, cost-effective, and time-efficient. Procedures rangefrom self-administered questionnaires to sophisticated diagnostic tests. Exercise programprofessionals should establish pre-participation screening procedures that are appropriate for

their clients or a facilitys target population. The Physical Activity Readiness Questionnaire (PAR-Q) has been recommended as a minimal standard entry into moderate-intensity exerciseprograms. The PAR-Q was designed to identify the small number of adults for whom physicalactivity might be inappropriate or those who should receive medical advice concerning the mostsuitable type of activity.

In addition, the ACSM and American Heart Association (AHA) have co-published apreparticipation screening questionnaire specifically designed for health/fitness facilities. Manysedentary individuals can safely begin a moderate-intensity physical activity program without theneed for extensive medical screening. However, it is recommended that persons interested inparticipating in organized exercise programs be evaluated for selected risk factors associatedwith the development of coronary artery disease (CAD) and for signs or symptoms suggestive ofcardiovascular, pulmonary, or metabolic disease.

Box 1. Major Signsor Symptoms Suggestive of Cardiovascular & Pulmonary Disease*

Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw, arms, or other areasthat many be due to ischemia

Shortness of breath at rest or with mild exertion Dizziness or syncope Orthopnea or paroxysmal nocturnal dyspnea

Ankle edema Palpitations or tachycardia

Intermittent claudication

Known heart murmur

Unusual fatigue or shortness of breath with usual activities*These symptoms must be interpreted in the clinical context in which they appear because they

are not all specific for cardiovascular, pulmonary, or metabolic disease.

CAUTION: For additional questions and concerns regarding the preparticipation healthscreening and risk stratification guidelines, or to review AHA guidelines, please see yourphysician or professional health-care provider. DO NOT exercise if the guidelines suggestthat you need clinical evaluation or a physicians release. DO NOT exercise if you do not feelcomfortable starting an exercise program without the prior counsel or your physician orprofessional health-care provider.

Source: ACSMs Guidelines for Exercise Testing & Prescription. 6th

Ed. (2000).

www.ronjones.org High-Per formance Heal th 2007

Get Fi t . Be St rong.

8/2/2019 Health Screening

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Prepar t ic ipat ion Heal th Screen ing & Risk St ra t i f i ca t ion(Ron Jones, MS, ACSM Health/Fitness Instructor, Corporate Wellcoach)

www.ronjones.org High-Per formance Heal th 2007

Get Fi t . Be St rong.

Table 1. Coronary Artery Disease Risk Factors Thresholds*Risk Factors: (Positive) Defining Criteria

Family History Myocardial infarction, coronaryrevascularization, or sudden death before 55years of age in father or other male first-degreerelative (i.e., brother or son), or before 65 years

of age in mother or other female first-degreerelative (i.e., sister or daughter)Cigarette Smoking Current cigarette smoker or those who quit

within the previous 6 months.Hypertension Systolic blood pressure of 140 mm Hg or

diastolic 90 mm Hg, confirmed bymeasurements on at least 2 separateoccasions, or on antihypertensive medication.

Hypercholesterolemia Total serum cholesterol of >200 mg/dl (5.2mmol/L) or high-density lipoprotein cholesterolof 130 mg/dL (3.4

mmol/L) rather than total cholesterol of >200mg/dL.Impaired Fasting Glucose Fasting blood glucose of 110 mg/dL (6.1

mmol/L) confirmed by measurements on atleast 2 separate occasions

Obesity Body Mass Index of 30 mg/m2, or waist girth

of >100 cm (39.4 inches).Sedentary Lifestyle Persons not participating in a regular exercise

program or meeting the minimal physicalactivity recommendations from the U.S.Surgeon Generals Report.

Risk Factors: (Negative)

High Serum HDL Cholesterol >60 mg/dL (1.6 mmol/L)*Use with Initial ACSM Risk Stratification Table 2.

Table 2. Initial ACSM Risk StratificationLow Risk

*( 1 risk factor)

Younger individuals (